Effect of dexmedetomidine on inflammatory factors level and cognitive function after femoral head replacement in elderly patients / 中国骨伤

OBJECTIVE@#To analyze the effect of dexmedetomidine on the inflammatory factors level and cognitive function after femoral head replacement in elderly patients.@*METHODS@#From January 2016 to December 2017, 60 elderly patients(more than 60 years old, and Grade I to II of ASA) treated with femoral head replacement were divided into three groups, and 20 in each group. All patients received midazolam, fentanyl, etomidate, cisatracurium anesthesia induction and sevoflurane inhalation anesthesia maintenance. The patients in group B and group C were first given 1.0 μg·kg⁻¹ of dexmedetomidine 10 minutes during the operation. The maintenance volume was 0.3 μg·kg⁻¹·h⁻¹ of dexmedetomidine(in group B) and 0.6 μg·kg⁻¹·h⁻¹ of dexmedetomidine(in group C) by pumping. The same amount of saline was given to the patients in group A in the same way. The time of extubation, wakefulness and recovery, the simple intelligent mental state score (MMSE), the incidence of postoperative cognitive dysfunction (POCD) and the levels of interleukin-6 (IL-6), interleukin-10 (IL-10) and S100β protein expression in the 3 groups were compared.@*RESULTS@#There were significant differences in the time of spontaneous breathing recovery, eye opening tome and the time of extubation, as well as the dosage of propofol among the three groups(0.05); but one hour after the operation, the levels of IL-6 IL-10 and S100β protein in group B and group C was statistically different from those in group A(<0.05). The IL-6 and S100β protein in group C were significantly lower than those in group B (<0.05), and IL-10 was significantly higher than that in group B (<0.05).@*CONCLUSIONS@#For elderly patients operated for femoral head replacement, dexmedetomidine can reduce the level of inflammatory factors level and propofol consumption, and the incidence of postoperative POCD is low, indicating a dose dependence of dexmedetomidine. But it is necessary to choose the right dose according to the patient's condition.

Impact of interleukin-6 on long-term prognosis in patients undergoing coronary drug-eluting stent im-plantation / 心血管康复医学杂志

Objective:To explore impact of serum level of interleukin(IL)-6 on long-term prognosis in patients un-dergoing intracoronary drug-eluting stent(DES)implantation.Methods:A total of 2017 patients,received success-ful DES implantation in our hospital from Feb 2010 to Feb 2013 were selected.According to IL-6 level change be-tween before and after surgery,they were divided into elevated IL-6 group(n=994)and decreased IL-6 group(n=1023),and both groups received postoperative follow-up of one,two and three years.Results:Compared with de-creased IL-6 group after one-year follow-up,there were significant rise in levels of high sensitive C reactive protein [(22.3 ± 6.0)ng/ml vs.(30.8 ± 7.0)ng/ml],low density lipoprotein cholesterol[(2.5 ± 0.9)mmol/L vs.(2.6 ± 1.0)mmol/L]and serum creatinine[(77.9 ± 34.9)μmol/L vs.(88.8 ± 35.6)μmol/L],and significant reduction in level of high density lipoprotein cholesterol[(1.1 ± 0.4)mmol/L vs.(1.0 ± 0.3)mmol/L]in elevated IL-6 group,P=0.001 all;compared with decreased IL-6 group after two-year follow-up,there were significant rise in target lesion revascularization rate(1.6% vs.3.1%)in elevated IL-6 group(P=0.021);compared with decreased IL-6 group after three-year follow-up,there were significant rise in target lesion revascularization rate(1.3% vs. 3.8%),cumulative incidence rate of MACE(9.8% vs.15.6%),accumulative mortality(1.6% vs.3.3%) and cardiogenic mortality(0 vs.1.1%)in elevated IL-6 group(P = 0.001). Conclusion:Compared with decreased IL-6 group,after coronary drug-eluting stent implantation,long-term prognosis of elevated IL-6 group is significantly poor.

Obstructive Sleep Apnea Affecting Platelet Reactivity in Patients Undergoing Percutaneous Coronary Intervention / 中华医学杂志(英文版)

<p><b>Background</b>The relationship between obstructive sleep apnea (OSA) and platelet reactivity in patients undergoing percutaneous coronary intervention (PCI) has not been defined. The present prospective, single-center study explored the relationship between platelet reactivity and OSA in patients with PCI.</p><p><b>Methods</b>A total of 242 patients were finally included in the study. OSA was screened overnight by polysomnography. Platelet reactivity was assessed with a sequential platelet counting method, and the platelet maximum aggregation ratio (MAR) and average aggregation ratio were calculated. All patients were assigned per apnea-hypopnea index (AHI) to non-OSA (n = 128) and OSA (n = 114) groups. The receiver operating characteristic curve analysis was used to evaluate the accuracy of AHI for high platelet reactivity (HPR) on aspirin and clopidogrel, and multivariable logistic regression was used to determine the independent predictors of HPR on aspirin and clopidogrel.</p><p><b>Results</b>Median AHI was significantly higher in the OSA group than in the non-OSA group (34.5 events/h vs. 8.1 events/h, Z = -13.422, P < 0.001). Likewise, median arachidonic acid- and adenosine diphosphate-induced maximum aggregation rate (MAR) in the OSA group was significantly higher than those in the non-OSA group (21.1% vs. 17.7%, Z = -3.525, P < 0.001 and 45.8% vs. 32.2%, Z = -5.708, P < 0.001, respectively). Multivariable logistic regression showed that OSA was the only independent predictor for HPR on aspirin (odds ratio [OR]: 1.055, 95% confidence interval [CI]: 1.033-1.077, P < 0.001) and clopidogrel (OR: 1.036, 95% CI: 1.017-1.056, P < 0.001). The cutoff value of AHI for HPR on aspirin was 45.2 events/h (sensitivity 47.1% and specificity 91.3%), whereas cutoff value of AHI for HPR on clopidogrel was 21.3 events/h (sensitivity 68.3% and specificity 67.7%).</p><p><b>Conclusion</b>Platelet reactivity appeared to be higher in OSA patients with PCI despite having received a loading dose of aspirin and clopidogrel, and OSA might be an independent predictor of HPR on aspirin and clopidogrel.</p>

Effect of intrahepatic cholestasis of pregnancy on the functions of hypothalamic-pituitary-adrenocortical axis and adrenal cortex in normal neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of intrahepatic cholestasis of pregnancy (ICP) on the functions of the hypothalamic-pituitary-adrenocortical (HPA) axis and adrenal cortex in normal neonates.</p><p><b>METHODS</b>Demographic characteristics, prenatal anxiety and depression, and perceived stress during delivery were investigated in 32 ICP women and 32 controls. The cord blood levels of cortisal, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate (DHEAS) were measured by the radioimmunity technique in normal neonates immediately after birth.</p><p><b>RESULTS</b>The scores of prenatal anxiety and depression in ICP women were significantly higher than those in controls (p<0.05 and p<0.01, respectively). There were no significant differences in the perceived stress during delivery between the two groups. The cord blood levels of cortisol and ACTH in neonates from ICP women were significantly lower (p<0.01), while the DHEAS level was significantly higher (p<0.01) than in neonates from controls. The DHEAS/ACTH ratio was significantly higher (p<0.01), while the cortisol/DHEAS ratio was significantly lower in the ICP group (p<0.01) than in the control group. The glycocholic acid level in ICP women was positively correlated with the DHEAS level in neonatal cord blood (r=0.47, p<0.01).</p><p><b>CONCLUSIONS</b>There may be a dissociation between cortisol and DHEAS in neonates with normal birth outcome from ICP women. ICP may result in a decreased responsiveness of HPA axis and an increased secretion of DHEAS by adrenal cortex in these neonates. This suggests that there might be dysfunction of the fetal zones of the adrenal cortex.</p>